Colorectal Cancer Awareness and Screening Guideline for African American Populations

Abstract

Background and context: Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening provides the best prospects for preventing the morbidity and mortality associated with the disease. Nurses have the duty to promote health and prevent diseases. However, low rates of colorectal cancer screening continue to be reported, especially among African Americans who continue to suffer disproportionately from the disease. A local clinic reports low CRC screening and high incidence of late stage CRC diagnoses. Aim: To develop a culturally-sensitive clinical practice guideline that nurses can use to educate patients appropriately on colorectal cancer. Strategy/Tactics: The health belief model informed the background, development, and implementation of this project. Evidence from peer-reviewed nursing literature was synthesized in a literature review matrix and then used to develop a clinical practice guideline to increase colorectal cancer screening. Program/Policy process: The AGREE II framework was used to develop the clinical practice guideline considering the 6 domains and the related 23 items. Outcomes: The low rates of CRC screening and disproportionately high rates among African Americans were linked to several problems that could be grouped into three classes: patient obstacles, provider issues, and system-level problems. Patient obstacles to CRC screening included fear, inadequate knowledge of CRC risk, and low apparent benefit of colonoscopy. Provider-level issues included failing to recommend screening and insufficient knowledge regarding guidelines and impediments to screening. Examples of system barriers included financial problems, lack of insurance, and the inability to access care. What was learned: Implementation of the clinical practice guideline when providing patient education to African American populations will eliminate disparities in colorectal cancer screening in this population.